Heart Health


>>ON “HEALTH MATTERS” TELEVISION FOR LIFE, KNOWING THE WARNING SIGNS OF A HEART ATTACK.>>I STARTED TO GET VERY HOT AND SWEATY AND THEN VERY COLD.>>A SPOKANE WOMAN SEEKS MEDICAL HELP JUST IN TIME.>>WHEN I GOT TO URGENT CARE, I THINK I WAS HAVING A HEART ATTACK AT THAT POINT.>>MORE THAN 1 MILLION AMERICANS HAVE HEART ATTACKS EACH YEAR. THEY STRIKE YOUNG AND OLD… MEN AND WOMEN. LEARN IF YOU ARE AT RISK AND WHAT TO DO IF A HEART ATTACK STRIKES.>>”HEALTH MATTERS” IS MADE POSSIBLE BY VIEWERS LIKE YOU, THE FRIENDS OF KSPS. AND BY PROVIDENCE HEALTHCARE.>>I’M DR. ANDREW BOULET, AND WHEN MY WIFE HAD A CARDIAC ARREST, I CHOSE PROVIDENCE BECAUSE I KNEW THAT EVERYTHING FOR HER COMPLEX CARE WAS AVAILABLE FROM THE EMERGENCY ROOM, TO RADIOLOGY, TO THE NURSING STAFF, TO THE SPECIALISTS WE NEEDED FOR HER CARE.>>MY NAME IS BETH PEREZ, AND I AM A REGISTERED NURSE, AND I WORK AT HOLY FAMILY HOSPITAL ON THE LABOR AND DELIVERY UNIT. I’M ABOUT TO HAVE MY SECOND CHILD, AND I CHOSE PROVIDENCE BECAUSE I LOVE AND TRUST THE PEOPLE THAT I WORK WITH, AND WHY WOULDN’T I SEEK CARE FROM THE PEOPLE I LOVE AND TRUST.>>GOOD EVENING. I’M YOUR HOST TERESA LUKENS, AND WELCOME TO ANOTHER EDITION OF “HEALTH MATTERS.” OUR TOPIC TONIGHT IS HEART HEALTH. A VERY TIMELY SUBJECT, SINCE FEBRUARY IS HEART MONTH. SO MANY PEOPLE ARE AFFECTED. IN FACT, HEART DISEASE IS THE LEADING CAUSE OF DEATH FOR BOTH MEN AND WOMEN IN THE UNITED STATES. HERE TO BRING US THEIR PERSPECTIVE AND EXPERTISE, OUR PANEL FOR THE EVENING. DR. SEAN SPANGLER IS WITH PROVIDENCE CARDIOLOGY. HE IS A CARDIOLOGIST WHO IS BOARD CERTIFIED IN CARDIOVASCULAR DISEASE AND INTERNAL MEDICINE. JEFF EMERY IS WITH NORTHWEST NEUROLOGICAL WHERE HE IS A FAMILY PRACTICE DOCTOR FOCUSING ON PREVENTATIVE MEDICINE. AMONG HIS MANY AREAS OF EXPERTISE, DR. EMERY WORKS WITH PATIENTS TO REDUCE THE RISK OF CARDIOVASCULAR DISEASE. SHAINA HICKS WORKS AT ST. LUKE’S REHABILITATION INSTITUTE WHERE SHE IS THE CARDIAC AND PULMONARY REHABILITATION PROGRAM LEAD. GREG LANG IS A PHYSICIAN ASSISTANT WITH ROCKWOOD CLINIC. HE WORKS AT THE HEART AND VASCULAR CENTER AND THE WOMEN’S HEART CLINIC. WELCOME. A VERY IMPORTANT TOPIC. WE’RE GOING TO GET RIGHT TO IT IN JUST A MOMENT. WE ALSO WANT TO WELCOME YOUR PHONE CALLS AND EMAILS THIS EVENING, TAKE ADVANTAGE OF OUR PANEL AND ASK YOUR QUESTIONS AND GET THEIR ADVICE THIS EVENING. I WANT TO TALK ABOUT THE SCOPE OF THIS. WE TALKED ABOUT HEART DISEASE BEING THE LEADING CAUSE OF DEATH FOR BOTH MEN AND WOMEN, AND THIS CAME OUT FROM THE AMERICAN HEART ASSOCIATION JUST THIS WEEK SAYING THAT TREATING AMERICANS WITH HEART DISEASE COULD COST $1.1 TRILLION DOLLARS, WITH A T, BY THE YEAR 2035. THE REPORT ALSO SAYS THE PACE OF AMERICANS BEING DIAGNOSED WITH HEART DISEASE IS INCREASING DRAMATICALLY, MORE THAN 40% OF PEOPLE IN THIS COUNTRY HAD SOME FORM OF HEART DISEASE IN THE YEAR 2015. WE’RE TALKING ABOUT A LOT OF PEOPLE, DR. SPANGLER. SET THE STAGE FOR US. WHAT ARE WE TALKING ABOUT WHEN WE SAY HEART DISEASE? IT’S A BROAD TOPIC.>>HEART DISEASE CAN BE A BROAD TOPIC. TYPICALLY WHEN WE TALK ABOUT HEART DISEASE USUALLY WE’RE TALKING ABOUT THE BUILDUP OF PLAQUE IN YOUR HEART ARTERIES WHICH CAN EVENTUALLY LEAD TO CHEST PAINS OR A HEART ATTACK. THERE’S MANY OTHER DISORDERS OR DISEASES THAT AFFECT THE HEART BUT THAT’S THE MOST COMMON ONE THAT DOES AND ULTIMATELY WHEN WE REFER TO HEART DISEASE THAT’S WHAT WE’RE TALKING ABOUT.>>WHEN WE TALK ABOUT 40% OF AMERICANS IN THE YEAR 2015 WITH HEART DISEASE, WHY IS THAT? WHY DO SO MANY PEOPLE IGNORE THE WARNING SIGNS OR DON’T WORK TO REDUCE THE RISK?>>WELL, UNFORTUNATELY A LOT OF PEOPLE ARE CHOOSING POTENTIALLY UNHEALTHY LIFESTYLES THAT CAN LEAD TO THINGS LIKE HIGH BLOOD PRESSURE, HIGH CHOLESTEROL, DIABETES. FORTUNATELY, LESS PEOPLE ARE SMOKING WHICH IS HELPING REDUCE THE RISK BUT TOO MANY PEOPLE ARE NOW OVERWEIGHT OR OBESE WHICH CONTRIBUTES TO THOSE RISK FACTORS, AND SO A LOT OF THAT CAN BE ADDRESSED BY CHOOSING HEALTHIER THINGS, BEING MORE ACTIVE, BETTER DIET, AND YOU CAN ADDRESS THOSE RISK FACTORS AND REDUCE YOUR CHANCE OF HAVING HEART DISEASE. UNFORTUNATELY, TO THIS POINT, WE’RE GOING THE WRONG DIRECTION WITH A LOT OF THOSE THINGS. BUT WE COULD TURN IT AROUND AND REDUCE THE COSTS OF HEART DISEASE CARE IN THE FUTURE.>>THE IDEA BEING PREVENTION, DR. EMERY. SO SO MANY PEOPLE WILL SAY, WELL, I DON’ HAVE A FAMILY HISTORY, AND, THEREFORE, I’M NOT AT RISK. THAT’S NOT THE CASE?>>RIGHT. THERE’S A NUMBER OF RISK FACTORS AND FAMILY HISTORY IS JUST ONE OF THEM. SO THE LACK OF FAMILY HISTORY DOESN’T GUARANTEE YOU AGAINST HEART DISEASE BY ANY MEANS, AND MOST — I TRULY BELIEVE MOST ADULTS OVER THE AGE OF 40 AND SOME EVEN EARLIER THAN THAT, ESPECIALLY IF THERE IS A FAMILY HISTORY, BUT ANY ADULT OVER THE AGE OF 40 WITHOUT A FAMILY HISTORY DESERVES A THOROUGH EVALUATION FOR RISK OF HEART DISEASE.>>WHERE DO YOU START WHEN IT COMES TO FAMILY HISTORY? FIRST OF ALL. MAKE SURE THAT YOU KNOW THAT BEFORE YOU EVEN BEGIN OTHER PREVENTATIVE MEASURES OR TESTING.>>YOU MEAN WHERE DO I BEGIN WITH FAMILY HISTORY?>>EXACTLY. WHAT DO I NEED TO KNOW, I GUESS?>>WELL, JUST CERTAINLY IF ANY FIRST-DEGREE RELATIVE, PARENTS, BROTHER, SISTER HAS HAD A HISTORY OF HEART ATTACK, OR STENTS, BYPASSES, ANYTHING OF THAT NATURE. BUT EVEN — I GO TO THE DISTANT FAMILY HISTORY AS WELL. THEN LOOK AT LIFESTYLE FACTORS, WHICH ARE BIG, AND DR. SPANGLER TOUCHED ON THOSE WITH DIABETES, SMOKING, HIGH BLOOD PRESSURE, HIGH CHOLESTEROL, SEDENTARY LIFESTYLE.>>WE’RE FINDING OUT MORE ABOUT TESTING AND THE TESTS THAT CAN BE USED AND THE WAY WE USE THAT INFORMATION.>>YOU KNOW, WHEN WE LOOKED AT — THIS IS FROM THE 1970s, REALLY, THE CHOLESTEROL PANEL, IT’S LIKE WATCHING A 1950s BLACK AND WHITE TV SET, AND WE DO HAVE 1080 HD NOW THAT WE CAN LOOK AT TO LOOK AT A LOT MORE THINGS OUTSIDE THAT REALM OF LDL, HMPLET DL AND TOTAL CHOLESTEROL. DR. EMERY DOES THE SAME THING I DO IS WE LOOK AT THOSE OTHER THINGS ASSOCIATED WITH HEART DISEASE, AND THEY’RE WIDESPREAD RIGHT NOW. I MEAN, SLEEP APNEA NOW HAS BEEN STUDIED AND LOOKED AT, AND IT’S A RISK FACTOR. LOW VITAMIN D IS A RISK FACTOR. AND THEN WE LOOK AT THE CHOLESTEROL PARTICLES, WHICH MEANS SO MUCH MORE THAN JUST THE CHOLESTEROL ITSELF. I MEAN, LDL DOESN’T CIRCULATE ON ITS OWN. IT CIRCULATES WITH TRIGLYCERIDES. SO DO WE IGNORE TRIGLYCERIDES AND JUST LOWER LDL? WELL, NO, WE HAVE TO LOOK AT WHAT KIND OF PARTICLES ARE CARRYING THOSE TWO MOLECULES AND HOW BIG THOSE MOLECULES ARE OR MORE IMPORTANTLY HOW DENSE THEY ARE. THE DENSER THEY ARE, THE MORE EASE THEY HAVE TO GET INTO THE ARTERIAL LININGS, AND THERE’S A LOT — THERE’S A BIG PICTURE AND THE INFLAMMATORY CONCERNS THAT WE HAVE BECAUSE, YOU KNOW, STABLE PLAQUE, WE KNOW THAT WE ALL SLOWLY PRODUCE THAT AS WE AGE, BUT WHAT MAKES STABLE PLAQUE BECOME UNSTABLE PLAQUE, AND UNSTABLE PLAQUE IS REALLY WHAT CAUSES DISEASE AND CAUSES YOU TO COME TO THE E.R. WITH CHEST PAIN, AND WE NOW KNOW THAT MAYBE SUGAR IS THE MAIN CULPRIT, AND DR. SPANGLER MENTIONED THAT DIABETES. THAT’S PROBABLY ONE OF THE BIGGEST RISK FACTORS THAT 10 YEARS AGO WE IGNORED, AND NOW I THINK I SPEND AS MUCH TIME DISCUSSING DIABETES AS I DO DISCUSSING CHOLESTEROL, BECAUSE OF THE ASSOCIATION WITH CARDIOVASCULAR DISEASE.>>AND THEN, SHAINA, WE BRAWNT TO BRING YOU INTO THE CONVERSATION. YOU SEE PATIENTS AFTER THEY’VE HAD A CARDIAC EVENT. ARE THEY NERVOUS ABOUT STARTING A REHAB PROGRAM BECAUSE OF THEIR SITUATION?>>YEAH, DEFINITELY, A LOT OF THEM COME IN AND THEY’RE REALLY SCARED. THEY JUST HAD A LIFE-CHANGING EVENT, WHETHER IT WAS A HEART ATTACK OR EVEN AN OPEN-HEART SURGERY, IT’S SCARY, AND IF YOU CAN’T USE YOUR ARMS, YOU KNOW, BECAUSE OF THE EXTERNAL PRECAUTIONS YOU HAVE, YOU DON’T REALLY WANT TO WALK AROUND BECAUSE YOU DON’T KNOW HOW MUCH YOUR HEART CAN HANDLE, SO IT’S REALLY GOOD FOR THEM TO COME INTO A CARDIAC REHAB PROGRAM BECAUSE THAT’S WHAT WE’RE GOING TO HELP THEM DO IS BE ABLE TO SAY, HEY, YOU KNOW, YOU CAN WALK FAR, YOU CAN WALK A LITTLE BIT MORE THAN WHAT YOU THINK YOU CAN, AND WE’RE GOING TO TELL YOU THAT YOUR HEART IS ABLE TO DO THAT. ON THE OTHER HAND, SOMETIMES THEY COME IN AND THEY SAY, OH, I JUST HAD A STENT PLACEMENT, I FEEL SO MUCH BETTER, I NO LONGER HAVE ANY CHEST PAIN, I JUST WANT TO GO. YOU KNOW, RIGHT OUT OF THE GATE. BUT IT’S LIKE, NO, ACTUALLY YOUR HEART NEEDS TIME TO HEAL. YOU NEED TO SLOW BACK DOWN.>>AND TALK ABOUT THE TEAM APPROACH. OBVIOUSLY YOU’RE WORKING WITH THEIR DOCTORS AND MAKING SURE THAT IT ALL COMES INTO PLAY.>>SO WE’RE MEDICALLY SUPERVISD PROGRAM FOR HEART. SO WE HAVE A SUPERVISING PHYSICIAN THAT COMES AND HE OVERSEES EVERYTHING THAT WE’RE DOING. WE HAVE A REGISTERED DIETITIAN, CLINICAL EXERCISE PHYSICIAN PHYS JITIONS, RESPIRATORY THERAPY AND WE ALL WORK TOGETHER. AND IF THERE IS A PROBLEM WE’RE GOING TO CALL THE CARDIOLOGIST OR WHOEVER IS WORKING WITH THAT PATIENT TO GET MEDICAL ADVICE.>>TYPICALLY HOW LONG DO YOU HAVE A PATIENT IN THE REHAB PROGRAM?>>SO IT DEPENDS ON THE INSURANCE AND WHAT THE INSURANCE WILL COVER, BUT TYPICALLY IF THEY’RE HIGH-RISK PATIENT WE CAN SEE THEM UP TO 36 SESSIONS, WHICH IS ABOUT THREE MONTHS. SO THAT’S A GOOD CHUNK OF TIME TO SEE THEM AND TO TALK TO THEM, TO REALLY HELP BUILD THEIR CONFIDENCE, AND WE’RE TALKING ABOUT KIND OF THE FAMILY HISTORY, THAT TYPE OF THING, A LOT OF PATIENTS COME IN AND WANT TO BLAME IT ON THE FAMILY HISTORY, BUT WE REALLY TALK TO THEM IS IT REALLY THE FAMILY HISTORY OR IS IT A GENERATION OF BAD HABITS? SO LOOKING AT THEIR LIFESTYLE.>>WELL, AND YOU OFTEN SEE THAT, I’M SURE, DR. SPANGLER, WITH PEOPLE WHO ARE IGNORING ANY KINDS OF WARNING SIGNS OR REFUSING TO BELIEVE THEY HAVE ANY KIND OF ISSUES.>>YEAH, THAT CAN HAPPEN. I THINK CERTAIN PEOPLE WHO THINK THEY ARE POTENTIALLY LOW RISK, THEY’RE JUST — IT’S NOT GOING TO HAPPEN TO THEM, THEY MAY IGNORE SOME SIGNS, AND YOU WANT TO BE VERY IN TUNE TO POTENTIAL SIGNS OR SYMPTOMS OF HEART DISEASE AND CATCH IT EARLY TO HOPEFULLY PREVENT SOMETHING LARGER DOWN THE LINE SUCH AS A HEART ATTACK OR SOMETHING THAT COULD BE MORE SERIOUS. SO THAT DOES HAPPEN SOMETIMES, YES.>>TALK ABOUT THE DIFFERENCE BETWEN MEN AND WOMEN. BECAUSE THERE ARE SOME DIFFERENCES WHEN IT COMES TO, ESPECIALLY LEADING UP TO A HEARTY VENT.>>YES, MEN AND WOMEN ARE DIFFERENT CORRECT AND TO SOME DEGREE WOMEN ARE PROTECTED A LITTLE BIT IN THEIR YOUNGER YEARS, BUT ONCE THEY GET TO MENOPAUSE AND BEYOND, THEIR RISK STARTS TO EQUAL MEN IN TERMS OF INCIDENCE OF HAVING HEART DISEASE. IN TERMS OF PRESENTATION, THEY CAN PRESENT A LITTLE DIFFERENTLY. WOMEN PRESENT A LITTLE DIFFERENTLY. DIABETICS PRESENT DIFFERENTLY. SOMETIMES SYMPTOMS IN WOMEN CAN BE MORE SUBTLE BUT SOMETIMES I SEE WOMEN WITH CRUSHING CHEST PAIN AND THEY HAVE THE CLASSIC SIGNS OF A HEART ATTACK. OTHER WOMEN MIGHT FEEL A LITTLE MORE SHORT OF BREATH, A LITTLE SWEATY, FEELING MORE FATIGUED, SOMETHING ALONG THOSE LINES AND IT MAY BE SULGT MORE OFTEN IN WOMEN THAN MEN. UNFORTUNATELY THAT MAKES IT HARD HER TO DIAGNOSE SOMETIMES IF THEY ARE HAVING A HEART EVENT.>>THAT TAKES US TO THE FACT THAT SOME OF THOSE CLASSIC SOMETIMES, IF YOU’RE NOT HAVING SOME OF THE TYPICAL SYMPTOMS OF A HEART ATTACK, LIKE CHEST PAIN OR SHORTNESS OF BREATH, IT’S NOT ALWAYS THE CASE, ESPECIALLY IN WOMEN. TONIGHT WE’LL HEAR FROM A WOMAN WHO DIDN’T FIT THE PROFILE AT ALL. IN FACT SHE GOT A HEART ATTACK AND HAD HELP JUST IN TIME.>>IT DIDN’T FEEL LIKE AN EMERGENCY AT FIRST, SO I DIDN’T RUSH TO THE EMERGENCY ROOM UNTIL IT GOT REAL SERIOUS.>>AT AGE 47, ANGELA FLINK DIDN’T THINK A HEART ATTACK COULD HAPPEN TO HER. YET IN WEEKS BEFORE IT HIT, SHE EXPERIENCED LITTLE HEALTH SCARES… “EPISODES,” SHE CALLS THEM. THERE WERE ANXIETY ATTACKS SHE’D NEVER HAD BEFORE. AND MORE.>>I WAS HAVING SOME SYMPTOMS OF RAPID AND HEAVY HEARTBEAT BUT THEY WOULD COME AND GO. I HAD PLENTY OF PERIODS WHERE I FELT PERFECTLY FINE.>>ANGELA DID WHAT A LOT OF PEOPLE DO. SHE WENT ONLINE, ATTRIBUTING HER SYMPTOMS TO THINGS LIKE OVER-THE-COUNTER MEDICATION AND CHANGING HORMONES. EVENTUALLY SHE MADE AN APPOINTMENT WITH A DOCTOR, BUT THINGS GOT WORSE BEFORE THAT VISIT. ONE FRIDAY, AFTER A DAY OF SHOPPING WITH HER SISTER, HER HEART BEGAN RACING.>>I STARTED TO GET VERY HOT AND SWEATY AND THEN VERY COLD.>>ANGELA WENT TO URGENT CARE, BUT WAS QUICKLY TAKEN TO THE ER.>>I WENT TO SACRED HEART IN AN AMBULANCE THROUGH FRIDAY 5:00 TRAFFIC ALL THE WAY DOWN DIVISION. THEY GOT ME IN IMMEDIATELY. I HAD ONE ARTERY THAT WAS 100% ARTICULATED, WHICH MEANS BLOCKED. THEY PUT A STENT IN THERE. I FELT PRETTY GOOD AFTER THAT.>>IT HAPPENED FAST. ANGELA ARRIVED AT URGENT CARE AT 4:00 AND WAS OUT OF SURGERY BY 7:30. SINCE HER HEART ATTACK, ANGELA HAS BEEN WORKING ON EATING BETTER. SHE ALSO EXERCISES AT HOME. BUT THE TOUGHEST PART OF HER RECOVERY MIGHT BE COMING TO TERMS WITH WHAT HAPPENED.>>NO FAMILY HISTORY. THAT IS WHY WHEN IT HAPPENED WHY I DIDN’T REALLY THINK AT FIRST I WAS HAVING A HEART ATTACK.>>ANGELA IS GRATEFUL FOR THE CARE SHE RECEIVED EVERY STEP OF THE WAY. AND SHE HAS THIS ADVICE…>>DON’T DIAGNOSE YOURSELF. GET CHECKED OUT IF YOU THINK THERE IS SOMETHING WRONG.>>SO, GREG, IS THIS SOMETHING YOU TYPICALLY HERE? IS THIS SORT OF A TYPICAL STORY?>>IT IS, AND WOMEN TRULY ARE DIFFERENT, AND WE ARE LEARNING MORE AND MORE ABOUT WOMEN’S SYMPTOMS AND THEIR MOST COMMON SYMPTOM IS SHORTNESS OF BREATH. IT’S NOT CHEST PAIN. AND IT’S THE — USUALLY THE MILDLY OVERWEIGHT FEMALE THAT MAY HAVE WHAT WE CALL LIKE PREDIABETES, MAYBE AT ONE POINT THEY’VE BEEN TOLD THAT THEIR BLOOD SUGARS WERE A LITTLE BIT HIGH, AND ALL OF A SUDDEN THEY CAN’T WALK UP A FLIGHT OF STAIRS BECAUSE THEY ARE SHORT OF BREATH AND THEY DON’T GIVE IT MUCH CONCERN, AND THEY MAY BE NOT SLEEPING WELL AT NIGHT, THEY MAY BE GENERAL FATIGUE AND THEY GO TO THEIR FAMILY PRACTITIONER, AND A LOT OF TIMES THOSE SIGNS EVERY MISSED, THAT SHORTNESS OF BREATH WOULD BE THE SAME THING IF YOU WALKED INTO YOUR FAMILY PRACTITIONER AND SAID, AS A MALE, I’M HAVING CHEST PAIN. WELL, THEY KNOW EXACTLY — OR YOU KNOW WHAT THEY’RE GOING TO FOLLOW UP WITH, BUT SHORTNESS OF BREATH, FATIGUE, SLEEPLESSNESS, ARE SO VAGUE, AND THEY’RE HARD TO DIAGNOSE. BUT WE NOW KNOW THOSE ARE IMPORTANT WARNING SYMPTOMS, ESPECIALLY IN THESE PERIMENOPAUSEAL FEMALES THAT HAVE OTHER RISK FACTORS, THE DIABETES, THE BODY MASS INDEX OVER 30, THE BLOOD PRESSURE THAT HOVERS IN THE 150s, KIND OF HARD TO CONTROL, THEY’RE IN A BUSY JOB, THEY’RE NOT GETTING UP OUT OF THEIR CHAIRS, THEY’RE SITTING ALL DAY, ALL THOSE ARE JUST LITTLE PIECES TO THAT PUZZLE, AND THEY ADD UP, AND ALL OF A SUDDEN, YOU KNOW, IF THEY WAIT TOO LONG, THEN THEY HAVE THOSE MORE TRADITIONAL SYMPTOMS AND SOMETIMES IT’S TOO LATE.>>SO IT’S NOT UNHEARD OF AT 47 YEARS OLD TO HAVE THOSE EXACT SYMPTOMS?>>NO. NOT AT ALL. DR. SPANGLER CAN ATTEST, I MEAN, I HAD THREE 53-YEAR-OLDS IN MY OFFICE TODAY THAT HAD STENTS PUT IN BEFORE THEY WERE 50. AND THEY LOOK, I GUESS, QUOTE-UNQUOTE, LIKE THEY’RE HEALTHY PEOPLE. NO FAMILY HISTORY. BUT IT’S –>>AND SHE DID SOMETHING I KNOW THAT FRUSTRATES YOU. I DON’T KNOW IF YOU CAUGHT THIS IN THE PIECE. SHE WENT TO THE INTERNET AND LOOKED UP HER SYMPTOMS.>>I’M OKAY WITH IT. I’M HAPPY — NO, I’M HAPPY WITH PATIENTS WHO ARE PROACTIVE AND TRYING TO TAKE CONTROL OF THEIR HEALTH AND — RATHER THAN IGNORING THEIR SYMPTOMS. SO I’M NOT UPSET IF PATIENTS DO THAT. SO –>>BUT THERE CAN BE SOME ISSUES WITH THAT? FOR INSTANCE, SHE IGNORED THE SIGNS, FOR ONE THING.>>YOU COU MISDIGGING YOURSELF – MS. DIAGNOSING YOURSELF MIGHT BE ONE THING OR MIGHT BE OVERLY REASSURED BY SOMETHING AND MISS SOMETHING. ULTIMATELY, NO, IF YOU’RE NOT AN EXPERT IN MEDICAL CARE, THEN YOU MAY BE MAKING THE WRONG CHOICE BY GOING ONLINE. I CAN UNDERSTAND THAT, YES, THAT POINT.>>TALK ABOUT SOME OF THE THINGS WE CAN BE DOING, DR. EMERY, TO PREVENT A SITUATION LIKE THAT, THE VERY THING THAT LED UP TO HER HEART ATTACK.>>ONE OF THE THINGS, I OFTEN TALK TO MY PATIENTS ABOUT NOT WAITING UNTIL YOU HAVE SYMPTOMS, BECAUSE BY THAT TIME YOU’RE IN A CRISIS MODE, AND UP TO A THIRD OF PATIENTS, THE FIRST SYMPTOM THAT THEY HAVE THAT THEY’RE HAVING HEART DISEASE IS SUDDEN CARDIAC ARREST. SO THAT’S WHY A LOT OF US ARE REALLY FOCUSED ON PREVENTION, WHICH REQUIRES US TO BE PROACTIVE AND LOOKING INTO OUR RISKS. ONE OF THE THINGS I DO IN A LOT OF PATIENTS, IT’S NOT A REAL COMMON TEST, BUT IT’S CALLED A CORONARY ARTERY CALCIUM STUDY, AND IT’S SOMETHING THAT LOOKS FOR CALCIUM WITHIN THE CORONARY ARTERIES, AND OFTEN SOMETIMES WE CAN CATCH PEOPLE VERY EARLY ON IN HEART DISEASE LONG BEFORE THEY PRESENT WITH SYMPTOMS. BUT I THINK A LOT OF WHAT WE DO IS TALKING TO PATIENTS ABOUT THEIR LIFESTYLE, AND THAT’S THINGS INVOLVING TRYING TO GET PEOPLE MOVING AND I TRY TO ENCOURAGE PATIENTS TO WORK UP TOWARDS A GOAL OF GETTING 30 MINUTES OF AEROBIC EXERCISE DAILY AND THEN A LOT OF TIMES IT’S WORKING WITH PEOPLE WITH WHAT’S GOING IN THEIR MOUTH, BECAUSE THAT ENDS UP IN YOUR ARTERIES. SO I ENCOURAGE PEOPLE TO FOLLOW A MODIFIED MEDITERRANEAN DIET, MINIMIZING RED MEATS, SATURATED FATS FROM ANIMALS, DAIRY, AND TRYING TO GET MORE FRUITS, VEGETABLES AND ELIMINATING A LOT OF PROCESSED FOODS IN THE DIET.>>WHEN IT COMES TO SOME OF THESE ADVANCED TESTS, DO I AS A PATIENT KNOW TO ASK FOR THAT, OR HOW DO I APPROACH THAT? DOES MY DOCTOR RECOMMEND THOSE TESTS? BECAUSE IF I DON’T HAVE A HISTORY OF HEART DISEASE AND I PRESENT AS BEING A FAIRLY HEALTHY WOMAN OR MAN, HOW DOES THE TESTING COME INTO PLAY?>>THAT IS HARD. TODAY YOU HAVE TO BE VERY PROACTIVE BECAUSE ONE OF THE TESTS THAT WE DO OFTEN DO WHEN PATIENTS ARE HAVING SYMPTOMS IS A STRESS TEST OR NUCLEAR STRESS TEST, AND THAT’S DESIGNED — IT’S STRENGTH IS TO FIND PEOPLE WHO HAVE CRITICAL CORONARY STENOSIS, BUT YOU CAN HAVE PRETTY SIGNIFICANT HEART DISEASE THAT’S NOT CRITICALLY NARROWING A VESSEL, BE TOLD THAT YOU PASSED WITH FLYING COLORS, AND I HAVE PATIENTS OFTEN THAT PASS THEIR STRESS TESTS AND WITHIN SIX MONTHS THEY HAD A HEART ATTACK. THEY SAID, HOW CAN THAT POSSIBLY BE? I WAS TOLD I WAS FINE. WELL, FACT IS YOU — AT THE MOMENT YOU HAD YOUR STRESS TEST YOU DIDN’T HAVE A CRITICAL NARROWING IN YOUR ARTERY, BUT YOU COULD STILL HAVE PRETTY SIGNIFICANT DISEASE IN YOUR CORONARY ARTERIES THAT THEN BECAME INFLAMED, ERUPTED, AND A BLOOD CLOT FORMED, WHICH BLOCKED THE FLOW OF BLOOD. SO IT DOES — YOU KNOW, IT’S — EPISODES — OPPORTUNITIES LIKE THIS TRYING TO GET THE WORD OUT TO PATIENTS THAT THERE ARE OTHER TETH THAT WE CAN DO TO LOOK FOR EARLY HEART DISEASE SO THAT WE CAN ENCOURAGE PATIENTS TO BE PROACTIVE IN THEIR APPROACH TO MANAGING THAT DISEASE.>>OKAY. WE HAVE A QUESTION FROM LORI HERE IN SPOKANE. GOOD EVENING, LORI,THANKS FOR WAITING.>>Caller: YEAH, I WOULD LIKE TO KNOW WHAT IS THE DIFFERENCE BETWEEN A SILENT HEART ATTACK AND A HEART ATTACK.>>A SILENT HEART ATTACK AND A HEART ATTACK. DR. SPANGLER?>>WE TYPICALLY REFER TO SILENT HEART ATTACKS, IT’S SOMETHING WE DIAGNOSE IN RETROSPECT. MEANING WE DO OFTEN SOME KIND OF TESTING, AND ELECTROCARDIOGRAM, AN ULTRASOUND OF THE HEART OR A STRESS TEST AND WE SEE THERE HAS BEEN SOME PRIOR DAMAGE TO THE HEART ON ONE OF THOSE TESTS, THAT THE PATIENT WAS UNAWARE OF, OR THEIR DOCTOR WAS UNAWARE OF. THAT’S WHAT WE CONSIDER TO BE A SILENT HEART ATTACK. IT NEVER CAUSED ANY SYMPTOMS BUT UNFORTUNATELY THEY HAD SOME PREVIOUS DAMAGE VERSUS A HEART ATTACK MEANING YOU PRESENT WITH WHATEVER SYMPTOM THAT WE TALKED ABOUT EARLIER, CHEST PAIN, SHORTNESS OF BREATH, YOU PRESENT TO THE EMERGENCY ROOM AND THEY DIAGNOSE YOU WITH A HEART ATTACK AT THAT PARTICULAR TIME. SILENT HEART ATTACK IS IMPORTANT TO RECOGNIZE BECAUSE IT MEANS YOU’VE ALREADY HAD A PREVIOUS HEART ATTACK WHICH SAYS YOU’RE AT A HIGH RISK OF HAVING A SUBSEQUENT HEART ATTACK. SO YOU WANT TO BE VERY AGGRESSIVE ABOUT AGAIN LIFESTYLE MEASURES AND TREATING RISK FACTORS TO HOPEFULLY PREVENT ANOTHER HEART ATTACK THAT MAY BE LARGER OR MORE SERIOUS THAN THE PREVIOUS SILENT HEART ATTACK.>>SHAINA, DO YOU RECOMMEND 30 MINUTES OF EXERCISE A DAY FOR PEOPLE?>>YEAH, THAT’S WHAT WE START OUT WITH. ANYTHING IS BETTER THAN NOTHING, OBVIOUSLY, AND SOME PATIENTS THAT COME IN, WE DON’T EVEN START THEM OUT FOR MAYBE SIX MINUTES, GIVE THEM A REST BREAK, AND THEN SIX MINUTES, BUT THE GOAL IS ULTIMATELY 30 MINUTES, FIVE TO SEVEN DAY AS WEEK, AND THEN GETTING THEM TO BE EVEN MORE ACTIVE THAN THAT.>>AND WHAT ABOUT HEART RATE, HOW DO YOU TARGET THE HEART RATE? WHAT ARE YOU LOOKING FOR IN IN A PATIENT REHABBING AND HOW ABOUT THOSE OF US IN OUR 40s OR 50s AND WHERE SHOULD OUR HEART RATE BE SITTING, HEART RATE, RES YIG HEART RATE AND EXERCISE HEART RATE.>>RESTING HEART RATE IS — IT’S A PRETTY WIDE RANGE FOR NORMAL. NORMAL IS BETWEEN 60 AND 100. SO THAT IS A PRETTY WIDE RANGE. SOMETIMES IF YOU’RE MORE ATHLETIC, BEING IN THE 50s OR 40s THAT CAN BE OKAY. OR SOME OF THE PATIENTS MIGHT BE A LITTLE BIT LOWER INTO THE 50s, DEPENDING ON WHAT MEDICATIONS THEY’RE ON, ESPECIALLY IF THEY’RE ON A BETA BLOCKER. IT MIGHT BE A LITTLE BIT LOWER DEPENDING ON WHAT THE DOCTORS WANT THAT TO BE. WITH EXERCISE, OUR MUSCLES ARE DEMANDING MORE OXYGEN AND MORE NUTRIENTS, SO OUR HEART RATE SHOULD BE COMING UP WITH EXERCISE, AND THEN COMING BACK DOWN APARTMENT A QUICK RATE, A GOOD RECOVERY RATE AFTER EXERCISE. IF THE PATIENT IS ON A BETA BLOCKER, THEN THERE’S NO REAL RESEARCH AND DR. SPANGLER MIGHT HAVE SOMETHING ELSE TO SAY ABOUT THIS, BUT I HAVEN’T SEEN ANY REAL RESEARCH SAYING THAT WE NEED TO TAKE A PATIENT UP TO THIS LEVEL. SO WE REALLY TEACH THEM ABOUT THEIR RATING OF PERCEIVED EXERTION, HAVING THEM RATE ON A SCALE OF 0 TO 10, HOW HARD DO YOU FEEL LIKE YOU’RE WORKING. AND THEN USING THAT AS A TOOL TO GAUGE WHEN THEY’RE OUTSIDE OF REHAB THAT IF I’M IN A MODERATE INTENSITY AT REHAB AND THEY’RE SAYING MY HEART IS OKAY BASED ON MY PRESSURE AND HEART RHYTHM, THEN I SHOULD BE AT A MODERATE INTENSITY WHEN I AM EXERCISING OUTSIDE OF THAT.>>SO IT’S KNOWING YOUR LIMITATIONS MORE THAN KNOWING WHAT YOUR HEART RATE IS AT.>>JUST REAL QUICK TO ADD, I’M MAKE A LITTLE MORE HARD-CORE BECAUSE I TRY TO GET THEM TO 40 MINUTES A DAY, BUT I DO RECOMMEND PEOPLE WILL HEAR 40 MINUTES A DAY AND SAY, WELL, I CAN’T POSSIBLY FIND 40 MINUTES IN MY DAY TO EXERCISE. AND THEY NEED TO — PEOPLE NEED TO UNDERSTAND THAT YOU CAN — IT DOESN’T MATTER IF YOU DO IT ALL AT ONCE OR FOUR 10 MINUTES OR EIGHT 5-MINUTE SESSIONS. SO A LOT OF TIMES PEOPLE ARE BUSY AND MY RECOMMENDATION IS ALWAYS, EVERY 55 MINUTES, THEY SIT AT A COMPUTER, YOU SET AN ALARM, YOU GET UP AND WALK FOR FIVE MINUTES EVERY HOUR. EVERY TIME YOU ANSWER THE PHONE YOU STAND. WHEN YOU HAVE A BUSINESS MEETING, IT’S A WALKING BUSINESS MEETING. SO YOU DON’T SIT AT A CONFERENCE TABLE, BUT YOU GET UP AND WALK. WALK THE HALLS OR WALK OUTSIDE. ALL OF A SUDDEN YOU CAN FIND THAT TIME TO EASILY GET THAT MINIMUM OF 40 MINUTES OF ACTIVITY.>>WE’RE PUTTING TOO MUCH EMPHASIS ON THE WORD “EXERCISE.”>>RIGHT, IT SHOULD JUST BE DAILY ACTIVITY. THAT’S WHAT — HUMANS HAVE MOVED FOR 400,000 YEARS, BUT WE STOPPED MOVING THE LAST — REALLY THE LAST 80 YEARS, AND WHEN WE TALKED ABOUT THAT INCREASE IN HEART DISEASE, WELL, THAT’S A PIECE TO THAT PICTURE, BECAUSE WE DON’T MOVE ANYMORE.>>OKAY. WE’VE GOT A FEW PHONE CALLS WAITING. WE WANT TO GET TO THOSE. LEWIS FROM MOSES LAKE, HI.>>Caller: HI. I ALWAYS ENJOY YOUR PROGRAM. MY QUESTION IS, I DON’T HAVE A FAMILY HISTORY OF HEART PROBLEMS, I DON’T SMOKE, I’M NOT OVERWEIGHT, MAYBE A LITTLE TINY BIT, I EXERCISE A LOT, AND I LIMIT THE AMOUNT OF MEAT THAT I EAT. IS THERE ANYTHING ELSE THAT I SHOULD DO THAT MIGHT BE GOOD FOR PREVENTING HEART TROUBLES?>>LEWIS, HOW OLD ARE YOU?>>I’M 74.>>JUST A YOUNG ONE.>>Caller: OH, I WISH.>>APPRECIATE YOUR PHONE CALL. ANY ADVICE FOR LEWIS?>>I MEAN, WE HAVE ALWAYS EMPHASIZED RED MEAT, BUT WE’RE MISSING THE BOAT, AND JEFF SAID IT EARLIER IT’S PROCESSED FOODS. IT’S PROCESSED FOODS. MEAT IS NOT UNHEALTHY IF IT’S EATEN WITH OTHER HEALTHY PRODUCTS. MEAT IS, I THINK, GIVEN A BAD RAP SOMETIMES BECAUSE IT’S BEEN SO PROCESSED WHEN IT’S RAISED. I MEAN, THE GRASS-FED BEEF, THE HORMONE-FREE BEEF IS WAY DIFFERENT IN ITS FAT COMPOSITION. IT’S SIMILAR TO WILD-CAUGHT SALMON, BUT I THINK WHERE WE GO AWRY IS THE PROCESSED FOODS THAT WE’RE SO USED TO GOING TO THE PANTRY. WE DON’T WORK FOR OUR FOOD ANYMORE. IT’S FREE. WE DON’T — WE DON’T HAVE TO HUNT AND GATHER IT, OF COURSE, BUT WE DON’T EVEN HAVE TO GO TO THE GROCERY STORE. WE CAN GO TO COSTCO ONCE EVERY TWO WEEKS AND BUY EVERYTHING AND KEEP IT IN THE PANTRY. BUT ALL OF THAT FOOD IS PROCESSED. IT’S INFLAMMATORY. ONE OF THE THINGS WE LOOK AT IS THOSE INFLAMMATORY MARKERS. DIABETES IS AN INFLAMMATORY DISEASE. HEART DISEASE IS INFLAMMATORY. WHAT CAUSES THAT STABLE PLAQUE TO BECOME SOFT PLAQUE AND RUPTURE? IT’S THE INFLAMMATION OF THOSE ARTERIAL WALLS, WHICH WE NOW KNOW, AND IT’S BEEN REINFORCED QUITE A BIT, IS BECAUSE OF SUGAR, BECAUSE OF THOSE PROCESSED CARBS.>>SO IF THERE IS ONE THING WE NEED TO GET OUT OF OUR DIET, IT’S SUGAR.>>OH, MY GOSH, YES.>>WE HAVE DAN IN SPOKANE. THANK YOU FOR WAITING.>>Caller: HI. I JUST WANTED TO COMMENT, I DO APPRECIATE ALL THE WORK YOU GUYS DO. I HAD A HEART ATTACK LAST MAY, AND IT KIND OF CAME UP ALL OF A SUDDEN. ACTUALLY I DO LAWN CARE FOR A LIVING, AND I WALK ABOUT, YOU KNOW, SIX TO EIGHT MILES A DAY THROUGH THE SUMMER, BUT, ANYWAY, I WAS — I THINK SOMETHING TO KEEP IN MIND FOR PEOPLE IS THAT I WAS DOING SOME STRESSFUL WORK ABOUT THREE DAYS BEFORE THE HEART ATTACK CAME, AND I DIDN’T REALIZE THAT AT THE TIME, I WAS CHANGING SOME TIRES IN MY GARAGE, AND I WAS KIND OF WORKING STANDING IN ONE PLACE RATHER THAN MOVING AND I THINK I PUT TOO MUCH APPRECIATE OUR MY SYSTEM AND RUPTURED SOMETHING. ANYWAY, IT WAS A GRADUAL DEAL. CAME LIKE ON A MONDAY A LITTLE BIT, THEN ON TUESDAY WORSE, AND THEN BY WEDNESDAY I COULD MOW A STRIP OF LAWN AND HAD TO QUIT BECAUSE OF THE PAIN. SO THAT NIGHT I WENT HOME AND FINALLY WENT IN AND HAD IT CHECKED OUT AND I HAD TO GET A STENT PUT IN, AND NITROGLYCERIN GAVE THE IMMEDIATE RELIEF IN THE HOSPITAL WHEN THEY FIRST GAVE THAT TO ME, BUT I JUST WAS WONDERING, SOMEBODY SAID THAT THE CHANCES OF HAVING ANOTHER HEART ATTACK IS PRETTY HIGH. I DON’T KNOW. IS THAT TRUE?>>DR. SPANGLER?>>A COUPLE THINGS. I’LL TOUCH UPON THE QUESTION HERE. YOU KNOW, AS IT IS, THE STENTS — OR EVEN HAVING BYPASS SURGERY DOES NOT CURE HEART DISEASE. SO YOU HAVE A BLOCKED ARTERY. IT CERTAINLY WAS IMMEDIATE RELIEF IN TREATMENT FOR THAT HEART ATTACK, WHICH IS A GREAT TREATMENT THAT WE HAVE THAT WE DIDN’T NECESSARILY HAVE 40 YEARS AGO. SO WE MADE GREAT ADVANCES, SOMEBODY COMES IN WITH A HEART ATTACK, A VERY UNSTABLE HEART SYMPTOM, WE CAN PUT A STENT IN, MAKE THEM IMMEDIATELY FEEL BETTER IN MANY CASES AND PREVENT HEART DAMAGE WHICH CAN BE A PROBLEM DOWN THE LINE. BUT UNFORTUNATELY YOU ARE SOMEBODY WHO DEVELOPED THAT BLOCKAGE IN YOUR ARTERY. SO IF YOU DID IT ONCE, UNFORTUNATELY, YOU’RE AT RISK FOR DOING IT AGAIN, WHICH AGAIN MEANS STRONG ATTENTION TO THINGS THAT HOPEFULLY PREVENT THAT. AGAIN WE HAVE TOUCHED UPON THAT QUITE A FEW TIMES TODAY ALREADY, POTENTIALLY WHAT ARE THE RISKS AND WHATNOT. I THINK ONE OF THE THINGS YOU TAKE AWAY WHEN YOU HAVE ONE OF THESE EVENTS, THANKFULLY I MADE IT THROUGH, I’M FEELING BETTER, BUT IT SHOULD BE A WAKE-UP CALL TO SAY WE NEED TO START DOING BETTER ON THE PATIENT SIDE OF IT AND ON THE DOCTOR SIDE WE HAVE A FEW DIFFERENT THINGS THAT WE CAN RECOMMEND IN TERMS OF MEDICATIONS TO HOPEFULLY PREVENT A SUBSEQUENT HEART ATTACK AS WELL. AND IT’S IMPORTANT TO TAKE THOSE MEDICATIONS AS THE DOCTOR RECOMMENDS.>>I WAS SURPRISED TO HEAR HIM SAY NITROGLYCERIN WAS STILL BEING USED.>>ALL THE TIME. IF YOU COME INTO THE EMERGENCY ROOM WITH CHEST PAIN, YOU’RE GOING TO GET NITROGLYCERIN 98% OF THE TIME. SO IT HELPS DILATE THE BLOOD VESSELS. YOU’RE NOT GETTING ENOUGH BLOOD FLOW THROUGH THERE. IT’S USED FOR PATIENTS WHO HAVE HAD HEART ATTACKS OR CHEST PAIN. THEY WILL OFTEN BE DISCHARGED HOME WITH A LITTLE BOTTLE THEY CAN TAKE AT HOME AT TIMES IF THEY’RE HAVING KIND OF STABLE CHEST PAINS. THE ONLY THING I WAS GOING TO SAY ABOUT HIM, GENERALLY THESE — A LOT OF THESE HEART SYMPTOMS ARE FAIRLY SUDDEN. AGAIN, YOU FEEL GREAT THE DAY BEFORE AND THE NEXT DAY YOU HAVE THE — HAVE A HEART ATTACK. IN THIS CASE IT WAS A COUPLE DAYS OF STUTTERING SYMPTOMS. THAT’S A FAIRLY TYPICAL PRESENTATION OF A HEART ATTACK. AGAIN, IT STILL MAKES IT VERY HARD FOR US BECAUSE AGAIN YOU COULD HAVE BEEN FEELING GOOD THREE OR FOUR DAYS AGO AND HOW DO WE PREDICT HE WAS GOING TO HAVE A HEART ATTACK. IT’S DIFFICULT. FINALLY, EVERYBODY HAS TO DO STRESSFUL THINGS, WHETHER IT’S STRESSFUL WORK OR EXERCISE THAT’S STRESSFUL. IN GENERAL I WILL SPEAK TO EXERCISE, I THINK PEOPLE WORRY, SHOULD I DO EXERCISE, AND THERE’S ALWAYS A SMALL RISK OF TRIGGERING HEART PROBLEMS WITH EXERCISE, BUT IN GENERAL, FOR EVERYBODY, LARGELY THE BENEFIT OF DOING AT LEAST MODERATE EXERCISE OUTWEIGHS THE SMALL RISK OF INCITING A HEART ATTACK, WHATEVER IT MIGHT BE. HE WAS DOING HEAVY WORK. WE SEE IT IN PEOPLE SNOW SHOVELING OVER THE WINTER. THAT CAN SOMETIMES TRIGGER HEART ATTACKS. IT’S LIFE, YOU HAVE TO DO SOME OF THOSE THINGS, THAT’S THE NATURE. WE CAN’T TELL ANYBODY NOT TO DO ANYTHING THAT’S HARD WORK. BUT CERTAINLY ON THE EXERCISE PORTION, AT LEAST — HEAVY EXERCISE YOU MAY WANT TO SOMETIMES AVOID. AGAIN, GENERALLY THE BENEFIT OUTWEIGHS THE RISK.>>WE HAVE FRED FROM MOSES LAKE ON THE LINE. HI, FRED.>>Caller: HI, HOW ARE YOU?>>VERY WELL. HOW ARE YOU?>>Caller: I’M GOOD. THANK YOU. THANK YOU FOR TAKING MY CALL THIS EVENING. I HAVE A QUESTION. I HAD A NUCLEAR STRESS TEST, AND THAT SEEMED TO COME OUT ALL RIGHT. I WAS HAVING SOME CHEST PAIN. THEN SO THEY DID A STRESS TEST. THEN THEY DID A NUCLEAR STRESS TEST. THAT TURNED OUT ALL RIGHT. BUT I FOUND — I HAD GONE THROUGH MY MEDICAL RECORDS, BECAUSE THAT SYSTEM THEY HAVE THAT YOU CAN GO ON AND TAKE A LOOK AT ALL THE MEDICAL REPORTS, BUT IN THERE WAS A REPORT THAT INDICATED THAT I HAD SOME — APPARENTLY SOME PLAQUE IN MY CAROTID ARTERIES. I’M NOT SURE — I’M NOT REAL UP WITH ALL THE MEDICAL — IF THAT HAS SOMETHING TO DO WITH THE HEART, AND I KNOW THAT THAT COULD CAUSE A STROKE, BUT NOT NECESSARILY ASSOCIATED WITH THE HEART. THE QUESTION IS, HOW SIGNIFICANT IS THE CAROTID ARTERY?>>VERY GOOD. DR. EMERY?>>WELL, I WOULD SAY WHEN WE DIAGNOSE PLAQUE ANYWHERE IN THE SYSTEM, AND WITH — THERE’S STUDIES TO SHOW IF WE FIND PLAQUE IN THE CAROTID ARTERIES, THERE’S PRETTY GOOD STATISTICAL CHANCE WE WOULD FIND IT IN THE ARTERIES IN THE HEART. AND SO ANY TIME I SEE PLAQUE ON A CAROTID SCAN, I CONSIDER THAT WHAT WE WOULD CALL A CORONARY OR HEART DISEASE RISK, OR RISK EQUIVALENT, AND THAT WILL OFTEN PROMPT ME TO — IF A PATIENT IS ASYMPTOMATIC I WOULD GET A CORONARY ARTERY CALCIUM SCAN TO BE ABLE TO SEE WHAT AREA OF DISEASE THEY MAY HAVE IN THEIR HEART. SO I LOOK AT THAT AS A VERY SIGNIFICANT, AND THEN THAT’S USUALLY WHAT ALSO PROMPTS ME TO, IN THAT PATIENT, TO ORDER LABS, LOOKING AT THEIR INFLAMMATORY MARKERS, THERE ARE SOME VERY SPECIFIC VASCULAR INFLAMMATORY MARKERS THAT ARE KIND OF — I OFTEN DESCRIBE IN PATIENTS AS SEISMOMETERS OF THEIR VASCULAR SYSTEM THAT CAN TELL US WHEN THEY’RE GETTING CLOSER TO RISK OF PLAQUE RUPTURE AND HAVING AN EVENT.>>SO FRED SHOULD ASK HIS DOCTOR MORE ABOUT THAT, THEN –>>I WOULD STRONGLY ENCOURAGE HIM TO, YES.>>WE HAVE TED IN LIBERTY LAKE. HI, TED.>>Caller: HI.>>THANK YOU FOR CALLING.>>Caller: THANK YOU FOR HAVING ME.>>DO YOU HAVE A QUESTION?>>Caller: YEAH, I DO. I’M 82 YEARS OLD, AND I FEEL GREAT. I MEAN, THE DOCTOR TELLS ME I’M A 60-YEAR-OLD NOW, BUT, YOU KNOW, THERE ARE THESE TESTS THAT ARE ADVERTISED RIGHT NOW, I THINK THERE’S FOUR ORE FIVE OF THEM, AND THEY’RE THE THE DISCOUNT OF $150, AND THEY’RE FOR BLOOD PRESSURE AND THINGS LIKE THAT, AND I JUST WONDERED, ARE THEY WORTH DOING?>>GREG, ARE YOU FAMILIAR WITH WHAT TED IS TALKING ABOUT?>>I THINK THERE’S A LOT OF DIFFERENT DIAGNOSTIC TOOLS OUT THERE. THERE’S SOMETHING CALLED LIFELINE SCREENING THAT DOES BASICALLY A QUICK LOOK AT YOUR ARTERIES, LOOKING FOR ARTHROSLAW ROTTIC PLAQUE, THE CORONARY CALCIUM SCORE THAT JEFF WAS TALKING ABOUT THAT KIND OF PREDICTIVE. IT DOESN’T — IT ISN’T ABLE TO IDENTIFY SOFT PLAQUE. THE ADVANCED LIPID MARKERS THAT WE GET ARE ALSO ANOTHER PIECE TO THAT PUZZLE. JUST BEING ABLE TO EXERCISE FOR SIX MINUTES IN WHAT WE CALL A BRUCE PROTOCOL IS A GOOD REPRESENTATION OF WHETHER YOU HAVE SIGNIFICANT DISEASE OR NOT, BUT SIR, YOU’RE GREAT AT 82 AND DOING WELL. SO THAT’S A HUGE BONUS. YOU GOT THAT DISEASE OF BIRTHDAYS WORKING AGAINST YOU, BUT BESIDES THAT, YOU KNOW, THE FACT THAT YOU HAVEN’T HAD ANY EVENT, THAT’S A BONUS. JEFF WAS SAYING ABOUT ANYBODY OVER THE AGE OF 40 SHOULD REALLY HAVE AT LEAST ONCE, AND I RECOMMEND THE SAME THING, AND WE DON’T DO A GREAT JOB OF ADVERTISING IT, BUT THAT’S WHERE SOMETHING YOU CAN TALK TO YOUR PRIMARY CARE PROVIDER, YOU KNOW — OUR CLINIC, I SEE ANYBODY THAT HAS AN INTEREST IN THAT, IT’S A LITTLE BIT OF OUT OF POCKET EXPENSE BECAUSE IT’S NOT FREE, BUT YOU DO GET A LITTLE BETTER PICTURE. THE KEY TO THAT IS ARE WE TRULY GOING TO TREAT YOU DIFFERENT? AND THE ANSWER MAY BE NO. BUT DO WE HAVE MORE INFORMATION TO GENERATE THAT PLAN OF CARE? DEFINITELY.>>ARE SOME PEOPLE FEARFUL OF GETTING THAT INFORMATION? WHAT I DON’T KNOW CAN’T HURT ME?>>I THINK IT IS. I THINK THERE IS A FACTOR BECAUSE, I MEAN, YOU FEEL HEALTHY, SO YOU KIND OF WANT TO WALK THAT PATH, BUT TO HAVE SOMEBODY TELL YOU THAT, WELL, YOU GOT TO MAKE CHANGE IN YOUR LIFE, OR YOU MAY BE — A MEDICATION MAY BE VERY BENEFICIAL FOR YOU, AND YOU’RE LIKE, I DON’T LIKE TO TAKE MEDICATIONS, WELL, THOSE ARE THINGS THAT PEOPLE MAYBE DON’T WANT TO HEAR, BUT –>>SHAINA, I WOULD THINK YOU HEAR THAT QUITE A BIT AS WELL.>>YEAH.>>PEOPLE JUST SORT OF RIDE THAT LINE, THAT THEY ONLY WANT TO DO AS MUCH AS THEY THINK THEY CAN DO AND NOT PUSH THEMSELVES, I GUESS.>>YEAH. DEFINITELY. LIKE DAVE WAS TALKING ABOUT BEFORE, THEY’RE SCARED. THEY DON’T REALLY KNOW. THAT’S WHAT CARDIAC REHAB, I THINK, IS ONE OF THE HUGE BENEFITS, IS THAT WE CAN TEACH THEM WHAT HAPPENED AND ALSO LOOK AT THEIR MEDICATIONS AND IMPROVE THE ADHERENCE TO THAT AND TEACHING THEM ABOUT NITRO THAT MAYBE THE DOCTOR DIDN’T HAVE TIME TO EXPLAIN THAT AND GO OVER THEIR RISK FACTORS. SO REALLY INDIVIDUALIZE THAT CARE WITH THEM.>>DO YOU FIND THAT THAT EMPOWERS THEM IN WAYS WHEN THEY GET TOWARD THE END OF THEIR REHAB?>>YES, BEING ADVOCATES FOR THEMSELVES AND REALIZING, OKAY, I CAN DO THIS, I DO KNOW HOW FAR I CAN PUSH MYSELF, I’VE LEARNED THOSE SAFE LIMITS TO EXERCISE, I’VE LEARNED WHAT THOSE RISK FACTORS ARE FOR ME AND HOW TO PREVENT A SECOND HEARTY VENT.>>SEAN, YOU WERE GOING –>>I JUST WANT TO TOUCH BASE. I WANT TO HAVE A COUNTERBALANCE TO WHAT HE IS SAYING — OR I GUESS THE ■GENERAL IDEA OF MORE% TESTING IS NOT ALWAYS THE RIGHT% ANSWER, THOUGH. YOU HAVE TO BE A LITTLE CAUTIOUS WITH THAT. HE MENTIONED AT ONE POINT HE WAS TALKING ABOUT, IF YOU DO — IF YOU’RE 82 AND YOU GET CAROTID ULTRASOUND AND YOU GET A STRESS TEST AND THOSE KIND OF THINGS, YOU THEN HAVE TO THINK ABOUT WHAT YOU’RE GOING TO DO WITH THAT AND JUST BE AWARE IF YOU GET A STRESS TEST THAT’S AN NORMAL, AND POTENTIALLY THAT% LAB, DOING A PROCEDURE, MAYBETH- STENTS, MAYBE SURGERY. I WANT PEOPLE TO BE AWARE, IT’S NOT THAT MUCH ADDED BENEFIT. IT SOUNDS LIKE IF YOU’RE GOING TO PUT MULTIPLE STENTS IN AND DO SURGERY. AS IT TURNS IN IN SOMEBODY NOT HAVING SYMPTOMS IT’S NOT THAT MUCH ADDED BENEFIT AS A HEALTHY @LIFESTYLE, TAKING AN ASPIRIN, MAKING SURE YOUR CHOLESTEROL, BLOOD PRESSURE IS UNDER CONTROL. YOU SOMETIMES OPEN UP THIS CHAIN OF EVENT AND HAVING MULTIPLE THINGS DONE WHEN IT DIDN’T ACTUALLY CHANGE YOUR POTENTIAL FOR LIVING A HEALTHY LIFE, REDUCTION OF HEART ATTACK, HOW LONG YOU’RE GOING TO LIVE. I JUST WANT TO MAKE SURE THAT PEOPLE ARE AWARE OF THAT. MOST THE TIME IN OUR CARDSOLOGY OFFICE IF YOU’RE ASYMPTOMATIC, WE’RE NOT DOING TOO MUCH TESTING. I THINK THERE IS A DIFFERENT POPULATION, A YOUNGER POPULATION WITH SOME RISK FACTORS, WHAT IS MY RISK WHEN I’M 50 YEARS OLD AND THOSE KINDS OF THINGS, IS A LITTLE DIFFERENT IN TERMS OF REDUCING THEIR RISK, VERSUS AN 82-YEAR-OLD ASYMPTOMATIC MALE WHERE YOU SAY MAKE SURE YOU TAKE @AN ASPIRIN, HEALTHY WEIGHT, THINGS.RESSURE, THOSE KIND OF- I DON’T WANT EVERYBODY THAT PUSHING THEIR DOCTORS FOR THOSE TESTS BECAUSE IT’S NOT ALWAYS THE RIGHT THING.>>I AGREE WITH YOU A HUNDRED PERCENT. @I WAS TALKING MORE GENERAL. I WOULD NEVER RECOMMEND FOR AN 82-YEAR-OLD FOR THE SAME REASON. BUT FOR THE GENERAL POPULATION IN THAT 40 TO 60 AGE GROUP THAT HAVE — AGAIN, IT’S NOT INVASIVE DIAGNOSTIC TESTING. IT’S JUST A BETTER PICTURE OF @WHAT WE CAN DO NON-INVASIVELY.>>VERY GOOD. BRENDA FROM NEWMAN LAKE. HI.>>Caller: HI. I HAVE A QUESTION ABOUT THE C REACTIVE PROTEIN TEST. I WAS WONDERING IF THAT’S A GOOD INDICATOR OF HEART DISEASE.>>DR. EMERY?>>C-REACTIVE PROTEIN, IT’S PROBABLY ONE OF THE LEAST SPECIFIC OF THE INFLAMMATORY% MARKERS. IT IS — THERE’S SO MANY THINGS THAT CAN AFFECT C-REACTIVE PROTEIN, INCLUDING AUTOIMMUNE DISEASE, INFECTION — THE LIST SO — THAT’S ONE OF THE REASONS WHY A LOT OF PHYSICIANS DON’T ORDER THAT BECAUSE IF IT COMES BACK POSITIVE WE REALLY DON’T KNOW WHAT TO DO WITH IT.>>CAN YOU EXPLAIN WHAT IT IS?>>WELL, IT’S JUST A MARKER OF GENERALIZED INFLAMMATION IN THE IS HIGH, AND IT’S NOTLAMMATION- NECESSARILY EVEN VASCULAR INFLAMMATION, THAT MAY BE HIGH, SOMEONE THAT HAS RHEUMATOID ARTHRITIS WILL HAVE AN ELEVATED C-REACTIVE PROTEIN. THE PROBLEM IS A POSITIVE TEST DOESN’T NECESSARILY GIVE PHYSICIANS A DIRECTION OF INVESTIGATION OR THERAPY. THERE ARE SOME MORE SPECIFIC VASCULAR MARKERS THAT I THINK GREG AND I USE PRETTY REGULARLY. THE NAMES WOULDN’T BE FAMILIAR, BUT MPL, THINGS LIKE THAT. SO THERE ARE SOME MORE SPECIFIC TESTS THAT GIVE US MORE DIRECTION OF THERAPY, BUT CRP IS OFTEN INCLUDED IN INFLAMMATORY PANELS, AND OBESITY, CENTRAL OBESITY DRIVES C-REACTIVE PROTEIN ELEVATIONS. IT IS FOUND IN ASSOCIATION WITH A HIGHER RISK OF VASCULAR DISEASE, BUT IT’S NOT A GREAT SCREENING TEST.>>OKAY. DR. SPANGLER, THERE’S A LOT OF MYTHS SURROUNDING HEART DISEASE AND I KNOW THAT YOU HEAR SOME OF THEM, ONE OF THEM BEING IF I TAKE CHOLESTEROL MEDICINE, I’M FINE, I’M NOT GOING TO HAVE ANYTHING — ANY KIND OF EVENT. BECAUSE I’M ON MY CHOLESTEROL MEDICINE.>>TRUE, YES, SOME PEOPLE VERY PROTECTED AND, THEREFORE, IF THEY ARE TAKING CHOLESTEROL MEDICINE THAT MEANS A SECOND HELPING AT DINNER, MAYBE THE MILKSHAKE, WHATEVER IT MAY BE. SO THERE’S A CERTAIN MINDSET THAT WE FIND. — THEY ACTUALLY LOOKED A THIS, THE PEOPLE WHO TAKE THE COMMON CHOLESTEROL MEDICATIONS MAY HAVE AN INCREASE IN THEIR WEIGHT AND DIFFERENT THINGS RELATED TO THE FACT THAT THEY’RE MORE LAX IN TERMS OF OTHER HEALTHIER CHOICES BECAUSE OF THAT. @>>AND DO YOU FIND THAT WITH @OTHER MEDICATIONS AS WELL? I’M ON A MEDICINE, IT WILL TAKE CARE OF THE PROBLEM. THE DOCTOR GAVE ME THIS MEDICINE, IT’S GOING TO TAKE CARE OF IT.% THAT’S TRUE. THAT’S HUMAN NATURE, UNFORTUNATELY, IS THAT HUMANS MAY FEEL PROTECTED IN TERMS OF I WAS GIVEN THIS MEDICINE SO I SHOULD BE FINE. WHICH, YOU KNOW, SOMETIMES WE WANT PATIENTS TO FEEL POSITIVE @AND WANT THEM TO FEEL REASSURED BUT AS WELL WE DON’T WANT THEM TO KIND OF RELAX IN TERMS OF>>OR GETTING ADVICE FROM FAMILY MEMBERS OR SOME OF THE OTHER THINGS THAT ARE FLOATING AROUND OUT THERE.>>CORRECT. SO, YOU CAN RUN INTO THAT PROBLEM AS WELL IN TERMS OF GETTING — YEAH, GET THE WRONG ADVICE OR WHATEVER, AND THEN THEY GET MISINFORMATION AND POTENTIALLY THAT MAKES KIND OF BAD INFLUENCE IN TERMS OF @DECIDING WHETHER TO TAKE THIS MEDICINE. SO, YES, THAT CAN HAPPEN.>>EARNEST FROM CALGARY.>>Caller: HI. HOW ARE YOU DOING?>>VERY WELL. THANK YOU FOR CALLING. AGE, AND I HAVE HIGH BLOOD- PRESSURE, AND THEY’RE TREATING ME WITH [INDISCERNIBLE] 60 MILLIGRAMS AND AMIDINE, 10 MILL GRAMGZ. THAT’S ONE OF MY QUESTIONS. I’M LOOKING TO SWITCH TO SOMETHING NATURAL. I AM MORE INTO NATURAL REMEDIES THAN I AM INTO THE TRADITIONAL, AND ALSO WHAT I WANTED TO MENTION, IN MY FAMILY THEY ALL DIED BETWEEN 48 AND 55, ALL MALES IN MY FAMILY. I’M THE LODG LONGEST LIVING IN T I ALSO WANT TO KNOW IF I WOULD DO — USE MY BICYCLE EVERY DAY, EXERCISE TO KEEP ME IN TONE? BECAUSE I I DON’T DO WELL ON ANY OTHER KIND OF EXERCISE. BUT A BIKE — I LOVE A BIKE AND I WOULD GO ON THE BIKE.>>WE’LL TACKLE BOTH OF THOSE. WE’LL START WITH SHAINA AND THE EXERCISE. HE LIKES HIS BIKE.>>YEAH, I MEAN, YOU WANT TO DO% SOMETHING THAT YOU ENJOY DOING.% SO IF BICYCLING IS SOMETHING YOU REALLY ENJOY, YOU KNOW, START OFF SLOW AND WORK YOUR WAY UP TO THE 30 MINUTES AT LEAST JUST LIKE WE WERE TALKING ABOUT, AND, YOU KNOW, THE AEROBIC EXERCISE IS VERY IMPORTANT FOR HEART HEALTH, BUT I ALSO AM A STRONG BELIEVER IN STRENGTH TRAINING, TOO, AND STARTING OUT WITH WEIGHTS, YOU KNOW, TALKING TO SOMEONE ABOUT WHAT WOULD BE SPECIFIC — WHAT WOULD BE GOOD FOR YOU, MAYBE GOING TO A STRENGTH TRAINING CLASS WHERE YOU WOULD HAVE AN INSTRUCTOR, BUT THAT’S ANOTHER IMPORTANT THING.>>SO THE BIKE IS A GREAT. HE LIKES DOING IT AND THAT’S GOOD. @AND THEN HE IS TALKING ABOUT HI MEDICATION AND ALSO TRYING TO INCORPORATE POSSIBLY SOME NATURAL REMEDIES.>>WELL, IT’S HARD TO MAKE A- RECOMMENDATION WITHOUT KNOWING YOU BETTER, BUT YOU KIND OF GOT TO GO BACK TO WHY DO WE TREAT BLOOD PRESSURE AND WHAT’S A SAFE BLOOD PRESSURE, AND I IMAGINE THAT YOUR PHYSICIAN HAS MADE THE DECISION THAT YOUR BLOOD PRESSURE WAS HIGHER THAN WHAT WE BELIEVE IS WITHIN THAT SAFE CATEGORY, AND YOU’RE ON TWO MEDICATIONS MOST LIKELY BECAUSE ONE MEDICATION DID NOT GET YOU TO THE LEVEL THAT YOUR PHYSICIAN FELT THAT WAS THE MOST HEALTHY OR THE SAFEST FOR YOU, AND SO WHETHER THERE’S A HOME REMEDY THAT WILL WORK AS WELL AS THOSE MEDICATIONS, I DON’T THINK SO, BUT EXERCISE WILL PROBABLY BENEFIT YOU MAYBE FIVE TO 10% MILLIMETERS OF IMPROVEMENT, AND THAT’S DAILY EXERCISE. SO THAT’S A GOOD STARTING POINT. IF YOU’RE ALREADY EXERCISING AND YOUR BLOOD PRESSURE IS STILL @SLIGHTLY ELEVATED, WEIGHT LOSS, AGAIN, 10 POUNDS OF WEIGHT LOSS CAN IMPROVE 5 MILLIMETERS OF% MERCURY FOR THAT BLOOD PRESSURE. SO EXERCISE DAILY. LOSE 15 POUNDS. AND MAYBE YOU’RE NOT TAKING THE AMILOTIPENE, AND YOU’RE CLOSER TO THAT BLOOD PRESSURE GOAL. SALT HAS ALWAYS KIND OF PLAYED A ROLE.% IF YOU ARE NOT IN HEART FAILURE, IT PROBABLY DOESN’T PLAY A HUGE ROLE, BUT AGAIN, THAT’S ANOTHER PIECE THAT PUZZLE, IF YOU ARE EATING A LOT OF PROCESSED FOODS, THERE’S A LOT OF SALT IN THOSE. EVEN THOUGH YOU DON’T THINK YOU @SALT YOUR FOOD, YOU’RE PROBABLY GETTING OVER THE AMOUNT WHICH IS RECOMMENDED OF SALT IN YOUR DIET. SO I DON’T — I MEAN, IF YOUR BLOOD PRESSURE IS AT A POINT% WHERE A PHYSICIAN FELT THAT IT NEEDED TO BE TREATED, I DON’T THINK A SUPPLEMENT OR SOME OVER-THE-COUNTER IS GOING TO BE ABLE TO ACCOMPLISH THE JOB.>>ARE YOU A FAN OF ANY SUPPLEMENTS FOR — PRESSURE.AH, BUT NOT FOR BLOOD- I MEAN, VITAMIN D AND OMEGA 3 ARE, I THINK HUGELY IMPORTANT, AND IF I LIVED IN SEATTLE AND I ATE FISH EVERY DAY THEN I PROBABLY WOULDN’T PROMOTE VITAMIN — OR OMEGA 3s AS MUCH. IF I LIVE BACK IN COLORADO AND I SAW THE SUN ALL THE TIME I MIGHT NOT PROMOTE VITAMIN D. BUT THOSE ARE THE TWO. I DON’T KNOW ABOUT THE REST OF THE GROUP, BUT THOSE ARE THE TWO I RECOMMEND.>>OKAY. I WANT TO GET TO AN EMAIL FROM MAUREEN WHO SAYS, HOW DO YOU TELL WHETHER OR NOT CHEST PAIN ON THE LEFT SIDE IS INDICATIVE OF A HEART ISSUE OR A LUNG THAT’S MAUREEN IN SPOKANE ASKING THAT QUESTION.>>WELL, SO, CHEST PAIN CAN REPRESENT MANY THINGS, TO INCLUDE POTENTIAL HEART PROBLEM OR A LUNG PROBLEM. TYPICAL CHEST PAINS RELATED TO THE HEART, THEY DON’T HAVE TO BE LEFT SIDED. CERTAINLY IN THE CENTER OF THE CHEST IS COMMON. CHEST PAINS FROM THE HEART WILL USUALLY LAST FROM A FEW MINUTES UP TO 15 OR 20 MINUTES. TYPICALLY THEY’RE MORE OF AN ACHE OR A TIGHTNSS THAN AN ACTUAL PAIN. SO FREQUENTLY I’LL BE TALKING TO MY PATIENTS ABOUT THEIR CHEST PAIN. NO, DOCTOR, IT’S NOT A PAIN, IT’S AN ACHE OR A TIGHTNESS. AND THEN GOOD TO HAVE SOME — COULD HAVE SOME ASSOCIATED SYMPTOMS. WE TALKED ABOUT BEING SWEATY OR SHORT OF BREATH. LUNG PAINS ARE DIFFERENT IN THE RESPECT IF IT’S — OFTENTIMES YOU’LL HAVE MAYBE SOME COUGHING GOING ALONG WITH THAT OR WHEEZING. IT MAY GET WORSE WHEN YOU TAKE A BIG BREATH. SO THE INFLAMMATION WITHIN THE SPACE AROUND THE LUNGS WILL MAKE IT WORSE WHEN YOU BREATHE IN. USUALLY OFTEN YOU CAN DISCERN A LUNG PAIN FROM HEART PAIN IN THAT WAY. BUT THERE’S NO PERFECT SCIENCE, BUT THOSE WOULD BE SOME FEATURES.>>ALLISON FROM MOSES LAKE, GOOD EVENING. @>>Caller: GOOD EVENING.>>THANK YOU FOR WAITING.>>>>Caller: THAT’S OKAY.>>DO YOU HAVE A QUESTION?>>YEAH, I HAD CONGESTIVE HEART FAILURE IN NOVEMBER. IT WAS STRESS. I WAS TRYING TO CARE FOR A HUSBAND, DO EVERYTHING THROUGH THE DAY, CLOTHES, AND HE IS IN A @CARE CENTER, AND I’M AT ANOTHER STATION. SO IT WAS TOO MUCH. WHAT I HAD WAS NAUSEA. I DO NOT HAVE HEART PAINS. I’VE HAD BYPASS 23 YEARS AGO, AND SO I’VE HAD QUITE A FEW STENTS, BUT THIS LAST TIME IT WAS FIVE DAYS IN THE ICU, AND I AM NOW ON — WHICH I NEVER HAD BEFORE — LASIX, AND I FIND, OF COURSE, I DRINK MYSELF TO DEATH WITH WATER. THEY TOLD ME BECAUSE OF ELEVATED HEART. AND I WONDERED IS THAT SOMETHING I WILL BE ON FOR A LONG, LONG TIME. OF COURSE, I’M BACK ON PLAVIX, WHICH YEARS AGO I HAD, BUT I’VE HAD A LITTLE BIT OF EVERYTHING.E SO WHAT CAN I EXPECT WITH THESE OTHER NEW PRESCRIPTIONS?>>AND HOW LONG YOU MIGHT BE ON THEM?>>YES, ESPECIALLY THE LASIX, BECAUSE I’VE ONLY KNOWN OF THAT YEARS AGO WHEN MY MOTHER HAD IT. IT WAS NEW TO ME.>>WHO WOULD LIKE TO TACKLE THAT?>>I WOULD BE HAPPY TO, I GUESS. A COUPLE THINGS. SO, THE CONGESTIVE HEART FAILURE IS TYPICALLY FLUID RETENTION IN THE LUNGS OR OFTEN PEOPLE SEE IT IN THE LEGS BECAUSE THE HEART IS NOT PUMPING WELL ENOUGH AND SO THE FLUID KIND OF BACKS UP. SO YOU ACTUALLY GET FLUID BACKING UP ALL THE WAY INTO THE ABDOMINAL AREA AND SOME PEOPLE WILL PRESENT WITH NAUSEA RELATED TO THAT. SO THAT MAY EXPLAIN WHY THAT IS. YOU WOULDN’T NECESSARILY HAVE CHEST PAIN. AND SO A WAY TO TREAT THAT IS TO GET RID OF THAT CONGESTION, GET RID OF THAT FLUID AND THAT’S WHAT LASIX DEPENDS. IT DEPENDS ON WHAT WAS CAUSING THE CONGESTIVE HEART FAILURE. IF THEY ARE ABLE TO IDENTIFY THAT AND FIX THAT, THAT MAY IMPROVE TO THE POINT WHERE SHE WOULDN’T RETAIN FLOOND SHE COULD GET OFF LASIX. ON THE OTHER HAND, IF IT SEEMS TO BE AN ONGOING PROBLEM, THEN WE FREQUENTLY WILL HAVE PATIENTS WHO HAVE TO STAY ON LASIX FOR THE REST OF THEIR LIFE, IF NOT MONTHS OR YEARS, TO KIND OF KEEP HER SYMPTOMS FROM COMING BACK AND KEEP THAT FLUID FROM COMING BACK. SO IT JUST — I CAN’T SAY FOR SURE.% IT JUST DEPENDS ON THOSE TYPES OF FEATURES. BUT IT WOULDN’T BE UNCOMMON FOR HER TO BE ON LASIX FOR A LONG PERIOD OF TIME.>>AND THAT — AND IT WOULD BE FINE? I THINK SHE IS WORRIED ABOUT SIDE AEROBIC EXERCISE PECTS EFFE>>POTENTIAL YOU CAN HAVE SOME INJURY TO THE KIDNEYS WITH LASIX BUT OVERALL THERE’S NOT LONG-TERM TALKIS TEA FROM ITS USE AND IT’S SAFE AS LONG AS IT’S MONITORED. @I’M SURE THE DOCTOR WILL BE MONITORING FOR SIDE EFFECTS. IT WOULD BE OKAY. IT WOULD BE CERTAINLY ADVISED SO SHE WOULDN’T START FEELING POOR AGAIN.>>GREG, YOU BROUGHT UP THE TOPIC OF SALT AS A CULPRIT. @HHOW MUCH SALT OR MILLIGRAMS SHOULD W BE LOOKING FOR?>>IT’S A GREAT QUESTION. I WOULD RATHER HAVE PEOPLE EAT FOODS THAT DON’T HAVE LABELS SO THAT AND THEN YOU CAN SALT THE FOOD. DEPENDING ON THE LITERATURE THAT YOU READ, BETWEEN 2 AND 4 GRAMS IS PROBABLY SAFE.% I THINK THERE’S A LOT OF EMPHASIS PUT ON LOW-SALT DIETS WHERE WE GET UNDER 2 GRAMS OR UNDER 1.5 GRAMS, AND I DON’T KNOW IF THE RESEARCH SUPPORTS THAT. ESPECIALLY IN REFERENCE TO MAYBE IT’S — THERE’S SOME DETRIMENTAL EFFECTS OF THAT. I THINK IF WE START TO LOOK AT THE AMOUNT OF SALT, IF YOU ARE EATING FOOD THAT’S COME OUT OF OF YOUR PANTRY, YOU’RE EASILY GOING TO BE AT 4 GRAMS OR MORE. @A LITTLE CAN OF V8 JUICE HAS ABOUT 600 MILLIGRAMS. SO IT’S — YOU KNOW, IF YOU HAD YOUR CAMPBELL’S SOUP THAT — OR ASPRES OWE — — ASPRES OWE, THAT’S SUPPOSED TO BE HEALTHY, PROBABLY HAS 1200 MILLIGRAMS PER SERVING.% THAT ADDS UP.>>WE ARE STARTING TO RUN SHORT ON TIME. I DO WANT TO GET SOME FINAL THOUGHTS A FEW SECONDS FROM ETCH A OF YOU ON JUST SORT OF SOME LAST THOUGHTS ON HEART DISEASE AND THE ADVICE YOU WOULD PUT OUT THERE TO THE VIEWERS. DR. SPANGLER?>>GOSH, THERE’S A LOT OF ADVICE TO PUT INTO A FEW SECONDS HERE. I AM GOING TO TOUCH UPON WHAT WE SAID BEFORE ABOUT ACTIVITY. HEART DISEASE IS A SITTING DISEASE, AND SO I’M EITHER GOING TO PIGGYBACK ON THE 30 MINUTES A DAY — ACTUALLY YOU SHOULD BE UP ON YOUR FEET THE MAJORITY OF THE DAY.% POOR EXERCISE FITNESS IS AS BIG A RISK FACTOR AS ANYTHING ELSE. I THINK REMEMBER THAT MANTRA.>>I — YOU KNOW, LIFESTYLE IS A BIG PART OF PREVENTION. @MOVING, EATING HEALTHY, GETTING ADEQUATE SLEEP, TRYING TO MANAGE STRESS, AND NEXT TIME YOU’RE IN TO SEE YOUR DOCTOR, MAYBE TALK ABOUT STEPS YOU COULD DO TO LOOK INTO YOUR RISKS.>>VERY GOOD. SHAINA, I THINK I KNOW WHAT% YOU’RE GOING TO SAY.>>OF COURSE. KIND OF BOTH OF WHAT THEY’RE SAYING, THE EXERCISE AND THE DIET ARE HUGE, AND ESPECIALLY THEY CAN AFFECT A LOT OF THE RISK FACTORS, ELIMINATING OR EVEN CHANGING SOME OF THOSE THINGS, BUT REALLY I THINK IT’S TAKING ONE THING AT A TIME, THEN BUILDING UPON THAT.ALS AND->>QUICKLY, DR. LANG.>>I GUESS THAT’S THE KEY TO THIS.% I WOULD RATHER HAVE PATIENTS FAT AND FIT THAN THIN AND UNFIT. EXERCISE OR REGULAR DAILY ACTIVITY OUT TRUMPS EVERYTHING. THAT’S THE MAGICAL PILL.>>VERY GOOD. WE ALSO WANT TO REMIND YOU @TONIGHT THAT THERE’S AN IMPORTANT HEARTY VENT COMING UP FOR HEART MONTH, AND THAT’S NEXT WEEK. IT’S THE GO RED FOR WOMEN LUNCHEON. THE EVENT WILL BE HELD ON WEDNESDAY, FEBRUARY 22nd AT THE SPOKANE VE! CONVENTION CENTE @TICKETS ARE $125 PER PERSON. YOUR TICKET WILL HELP SUPPORT THE AMERICAN HEART ASSOCIATION AND THEIR GREAT WORK. ATTENDING WE HAVE POST ADD LINK ON OUR WEBSITE. JUST GO TO KSPS.ORG AND CLICK WHERE IT SAYS “HEALTH MATTERS.” AND THAT WILL DO IT FOR THIS EDITION OF HEALTH MATTERS. OUR THANKS TO EVERYONE WHO CALLED IN OR EMAILED A QUESTION% AND, OF COURSE, TO OUR PANEL. WE HOPE YOU’LL JOIN US ON MARCH 23rd WHEN OUR TOPIC WILL BE INJURY PREVENTION AND FITNESS. WE HAVE TEAMED UP WITH THE ACADEMY OF SPORTS PERFORMANCE WHO WILL SHOW US WHAT TO DO IF YOU HAVE LOW BACK PAIN OR KNEE PAIN, PLUS THE PERFECT EXERCISE TO HELP OUT YOUR CALVES, FEET AND SHINS. AGAIN, THAT’S COMING UP IN MARCH ON KSPS. UNTIL THEN, THANK YOU FOR WATCHING AND, AGAIN CALLING AND EMAILING. WE APPRECIATE IT. @I’M TERESA LUKENS. GOOD NIGHT.,>>”HEALTH MATTERS” IS MADE POSSIBLE BY VIEWERS LIKE YOU, THE FRIENDS OF KSPS. AND BY PROVIDENCE HEALTHCARE. %>>I’M DR. ANDREW BOULET, AND WHEN MY WIFE HAD A CARDIAC ARREST, I CHOSE PROVIDENCE BECAUSE I KNEW THAT EVERYTHING FOR HER COMPLEX CARE WAS AVAILABLE FROM THE EMERGENCY @ROOM, TO RADIOLOGY, TO THE NURSING STAFF, TO THE SPECIALISTS WE NEEDED FOR HER CARE. %>>MY NAME IS BETH PEREZ, AND I AM A REGISTERED NURSE, AND I WORK AT HOLY FAMILY HOSPITAL ON THE LABOR AND DELIVERY UNIT. I’M ABOUT TO HAVE MY SECOND CHILD, AND I CHOSE PROVIDENCE BECAUSE I LOVE AND TRUST THE PEOPLE THAT I WORK WITH, AND WHY WOULDN’T I SEEK CARE FROM THE PEOPLE I LOVE AND TRUST.

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